Gabriel Scally

Trending now: future directions in digital media for the public health sector

BACKGROUND Digital media usage is expanding enormously and is starting to be used as a public health intervention and communication tool. It has an ability to increase the reach of public health research and communication, as well as drive measurable behaviour change. But there is an absence of both deep and wide understanding of the opportunities within digital media, i.e. most people think only of Facebook and Twitter when they think of social media; smart, strategic planning for its widespread use is not common practice and rigorous evaluative studies of its effectiveness are few and far between. METHODS This paper analyses the published literature on this topic and identifies the top 10 directions that use of digital media is likely to take in the medium term. RESULTS The analysis strongly supports the position that digital media needs to be taken seriously as a vehicle for public health activity in its own right and not merely as an adjunct to other campaigns. CONCLUSIONS Digital media will continue to develop and move from being an add-on to existing activity to being the major vehicle for significant elements of research, data collection and advocacy. It is important that public health leaders fully understand and engage in its development and use.

The importance of the past in public health

Study objective: To explore the role of history in public health and its relevance to current practice and professional development. Design: An analysis of the issues surrounding the poor attention paid to the history of public health by its current practitioners. Setting: The paper is written from the perspective of practitioners in the UK but has wide applicability. Main results: The paper makes the case that the current neglect of public health history is to the detriment of public health practice. Conclusions: There is a strong case for more attention to be paid to public health history in professional formation, development, and communication.

Adulteration of food: what it doesn’t say on the tin

The horse meat scandal is just the latest sign that we need a concerted effort to change our collective food culture

Environmental waste in health care.

Must be reduced for the overall carbon reduction strategy to succeed

Air pollution, deprivation and health: understanding relationships to add value to local air quality management policy and practice in Wales, UK

Background Air pollution exposure reduces life expectancy. Air pollution, deprivation and poor‐health status combinations can create increased and disproportionate disease burdens. Problems and solutions are rarely considered in a broad public health context, but doing so can add value to air quality management efforts by reducing air pollution risks, impacts and inequalities. Methods An ecological study assessed small‐area associations between air pollution (nitrogen dioxide and particulate matter), deprivation status and health outcomes in Wales, UK. Results Air pollution concentrations were highest in ‘most’ deprived areas. When considered separately, deprivation‐health associations were stronger than air pollution‐health associations. Considered simultaneously, air pollution added to deprivation‐health associations; interactions between air pollution and deprivation modified and strengthened associations with all‐cause and respiratory disease mortality, especially in ‘most’ deprived areas where most‐vulnerable people lived and where health needs were greatest. Conclusion There is a need to reduce air pollution‐related risks for all. However, it is also the case that greater health gains can result from considering local air pollution problems and solutions in the context of wider health‐determinants and acting on a better understanding of relationships. Informed and co‐ordinated air pollution mitigation and public health action in high deprivation and pollution areas can reduce risks and inequalities. To achieve this, greater public health integration and collaboration in local air quality management policy and practice is needed.

Crunch time for the government on alcohol pricing in England

Backtracking on the minimum unit price pledge would be a public health disaster

Tackling teenage pregnancy in the UK

The deleterious social and health outcomes of unplanned pregnancy have been recognized internationally for some time. In UK, birth rates among teenagers have not decreased; every year about 90,000 teenagers in England become pregnant. Of these, 7000 are under 16 years old. A report from UK governments Social Exclusion Unit sets out a comprehensive analysis of the problem and offers far-reaching recommendations on how the extent and consequences of the problem can be reduced. The recommendations cited take a determined multisectoral approach. As part of a national campaign, parents will be encouraged to talk with their children about sex, young men are motivated to be more responsible in their sexual behavior, and those who father children of teenage mothers are pursued vigorously to ensure the provision of continuing financial support. At the local level, local authorities and health authorities will have to develop a local strategy involving the wide range of groups that have an interest on the issue. Efforts must also be made to refute the idea that sex education lowers the age at first intercourse. In addition, it is suggested that the sexual health in UK adopt the integrated approach to produce an effective sexual health service.

Chief medical officers: the need for public health at the heart of government

As the global economic crisis continues to have detrimental effects on health and health services around the world, there has never been a greater need for powerful advocates for public health at the heart of government. The need for an articulate and authoritative voice that can tell elected politicians the potential health consequences of their actions and inactions has been recognised in many democracies since the pinnacle of the sanitary revolution of the 19th century. Many countries around the world have such a post designated in their governmental structures to provide expert advice on current and potential hazards to public health. There is, however, enormous variation in how this national role is positioned. In the countries of the European Union it ranges from a top level office occupied by a public health physician to a post at a lower level of government, or even separate from it, and occupied by an administrator rather than a physician.1 Perhaps the two most prominent posts globally are the surgeon general of the United States and the chief medical officer (CMO) of England, which incorporates the role of chief medical adviser to the UK government. These two posts show the advantages and hazards …

Healthy Cities Phase V evaluation: further synthesizing realism

In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases.

We must look further upstream to enable planetary health-literate urban development

www.thelancet.com/planetary-health Vol 2 April 2018 e145 The gap between academic research and real-world practice in urban planning and development is a major barrier to planetary health. By exploring uncertainty and complexity further upstream, we might be able to narrow that gap, and make progress in tackling the urban health crisis. The term upstreamism is used by public health specialists to highlight how urban environments— the hard infrastructure—affect health downstream. Specifically, it is the quality of the urban environment that affects health, and that quality is determined even further upstream by the people in control of the development and management of human habitats. The urban environment can therefore be more usefully described as midstream (panel). Achievement of healthy urban habitats is without doubt a complex challenge, which will require action at a systems level. Such an approach means working not only vertically via specialists and horizontally via interdisciplinary generalists, but also holistically. Planetary health must become integral to core global drivers of health such as education, equality, healthy technology, and international cooperation, and needs to be prioritised within targeted localised activities. The recent push for impact-focused interdisciplinary and transdisciplinary working practices in research is essential and should continue to expand. The mechanisms of local urban development decisionmaking are relatively simple when com pared with those of global systems, but they are still complex and messy. In local urban development, numerous disciplines and factors interface, including of course health and environmental sciences, but also economics, politics, corporate governance, risk management, social justice, ethics, law, psychology, and cultural history. Senior executives and other urban governors are the people who make decisions on the basis of multiple variables, both acknowledged and unacknowledged, including their response to variable political priorities. New transdisciplinary research methods that can navigate these complex and uncertain scenarios and model their potential outcomes are needed. How value is assigned in urban development decisionmaking (and more widely across most aspects of governance) is an important part of the equation. Mainstream valuation mechanisms are failing to help reach a sustainable equilibrium. Lord Stern described climate change as “the greatest market failure the world has ever seen”. “Not everything that can be counted counts, and not everything that counts can be counted” is a quote often attributed to Einstein, and is a concise summary of the predicament. Achieving agreement on valuation is particularly challenging in urban development; the appraisal of narrowly defined financial viability tends to dominate discussions on the value of development proposals. The positive news is that a good deal of progress has been made in the field of environmental economics and in the valuation of that which counts, but is not easy to count, although much more work is needed on making these valuations relevant to decision-makers. Many calls have been made from both inside and outside the academic community to engage much more fully on the achievement of real-world impact on planetary and human health, yet a substantial disconnection remains between the health world and the urban development world; efforts tend to be targeted at professionals whose limited influence lies midstream. In private sector-led economies (with We must look further upstream to enable planetary health-literate urban development